WOMEN IN EMERGENCY MEDICINE
questions. If the “boss” or “boyfriend” is present, they may refuse to leave the exam room, or they may insist on having control over certain situations such as functioning as the translator if foreign language interpretation is needed.
Identifiers for Sex trafficking: Some sex trafficking indicators include visits for multiple STIs or unwanted pregnancies, vaginal or anal foreign bodies (FBs), oral trauma, pelvic pain, use of slang of commercial sex work, branding on the body (i.e., “property of”), and lack of control regarding safe sex. Substance abuse is seen almost universally and should be viewed as a symptom.
Identifiers for Labor Trafficking: Labor trafficking indicators include signs of poor working conditions, injury due to lack of protective equipment, occupational injury with no worker’s compensation, chemical exposures, sun exposure, machine-related injuries, and ergonomic injuries. During a general examination, patients would appear overworked, malnourished, or anemic with considerably poorer hygiene. They may present as with excessive dental caries, have continuous muscle spasms, or nerve impingements resulting from repetitive motions.9
6 principles of providing Trauma-Informed Care Safety Trustworthiness + transparency Peer support Collaboration Empowerment + choice Recogninzing and addressing cultural, historicalo, gender stereotypes and biasis Figure 1: Six Principles of Providing Trauma-Informed Care. Source: Jennifer Reyes, DO FAAEM.
Practicing trauma-informed care can help patients feel comfortable and encourage them to be open about their situation. Knowing local trafficking laws and protections and having ready information about local social services organizations and local authorities can be essential. Many organizations provide emergency housing, long-term housing, counseling, family reunification, legal services, and job training for persons experiencing trafficking. For more information, guidance, and resources, call the National Human Trafficking Hotline at +1 (888) 3737888. Taking the time to provide this phone number to a patient during a private moment or posting such information in bathrooms can be another helpful and supportive measure providers can take. By practicing trauma-informed care and understanding what resources are available for PET, physicians can help play an important role in aiding patients in vulnerable situations.
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References
“Studies indicate that over 80% of PET come into contact with health care providers at some point during captivity and a majority of visits happen at the emergency department.”
1. Global Estimates of Modern Slavery: Forced Labour and Forced Marriage. (2017). [Report]. http://www.ilo.org/ global/publications/books/ WCMS_575479/lang--en/index. htm 2. Stahl, M. (February 2018). Trafficking Prevention and Disaster Response. Retrieved March 21, 2022 from 3. https://nhttac.acf.hhs.gov/ sites/default/files/2020-02/ Trafficking%20Prevention%20 and% 20Disaster%20 Response%20Literature%20 Review.pdf. 4. What is Trafficking in Persons? Retrieved March 21, 2022, from https://ctip.defense.gov/What-is-TIP/ 5. Blue Campaign | Homeland Security. Retrieved March 21, 2022, from https://www.dhs.gov/blue-campaign 6. FEMA - Emergency Management Institute (EMI) Course | IS-1151: Blue Campaign Disaster Responder Training. Retrieved March 21, 2022, from https://training.fema.gov/is/courseoverview.aspx?code=IS1151&d=11/17/2021 7. Bales, K. (2021). What is the link between natural disaster and human trafficking and slavery? Journal of Modern Slavery, 6(3), 36–47. https:// doi.org/10.22150/jms/MOJJ8604 8. U.S. State Department (2014). 2014 Trafficking in Persons Report. Retrieved March 21, 2022, from https://2009-2017.state.gov/documents/ organization/226846.pdf 9. Human Trafficking in the Emergency Department: Improving Our Response to a Vulnerable Population. The Western Journal of Emergency Medicine. Retrieved March 21, 2022, from 10. https://westjem.com/articles/human-trafficking-in-the-emergencydepartment-improving-o ur-response-to-a-vulnerable-population.html 11. Reyes, Jennifer. Human Trafficking in the Emergency Department. Grand Rounds Lecture Series, Staten Island University Hospital. June 23, 2021. Staten Island, New York, United States.